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Inside this issue:

Medical Humanities

1-3

Meet the Division

3

DME Activities & Pro- gram Calendar

4

There is a pervasive hesitancy for doctors to show the same humanity to Themselves that they show to patients.

of

the

Departments

and

the

University

Published

by

the

Volume 17, Issue 1 January 2006

Division

of

Medical

Ethics

Hospital

of of

Internal Medicine at LDS Utah School of Medicine

Medical Ethics in Utah

Medical Humanities meets The Impaired Physician

“Despite all our grand societies, memberships, fellowships, specialty colleges, each with its an- nual dues and certificates and ceremonials, we are horribly alone. The doctor’s world is one where our feelings—particularly those of pain, and hurt—are not easily expressed, even though

patients are encouraged to express them. trust our colleagues, we show propriety and ciprocity, we have the scientific knowledge,

We re- we

learn

empathy,

but

we

rarely

expose

our

own

where medicine intersects with the humanities to work collaboratively on health care dilemmas. This article focuses on just one of Dr. Jones’ en- gagements-- the Resident Conference—where she brought her medical humanities perspective to the problem of physician impairment. Dr. Jones tells us that in addition to having a personal impact, medical humanities can transform the culture of medicine and provide an intuitive cultural change for the larger community.

emotions. There is a

silent but terrible

collusion

to

cover up

pain,

to

cover

up

depression;

there

is

a

fear

of

blushing, a del quality

machismo that destroys us. The Cita- to medical training, where only the

fittest survive, creates the paradox empathetic physician…who shows

of the humane, little humanity

to himself…And so leagues is whisked particulars emerge, idea.’”

it is, when one of away, to treatment, the first response

our col- and the ‘had no

Abraham Verghese, The Tennis Partner,1 p.341

Among the many and varied activities of Therese (Tess) Jones, Ph.D., during her post- Thanksgiving visit, were her contributions to LDS Hospital’s Resident Medical Ethics Con- ference: Impaired Health Professionals: What to Do When Colleagues Need Help. At this ses- sion, she recommended reading the true story, The Tennis Partner,1 written by her colleague Abraham Verghese, M.D, that tells of his deep friendship with an intern who battled—and lost to—cocaine addiction. Dr. Jones is Associate Director of the Center for Medical Humanities and Ethics at the University of Texas Health Sci- ence Center in San Antonio, Texas. Dr. Verghese is Director. (He was also our 1999 Cowan Memo- rial Lecturer). Dr. Jones has designed and imple- mented a longitudinal, integrated humanities cur- riculum for the University of Texas School of Medicine. Those who were fortunate to meet her—at Grand Rounds, in her visits to courses, and at Physician, Student, and Women in Medi- cine Literature and Medicine discussion groups—

were consistently impressed with her depth and 16 breadth of ideas and insights about how and

At Risk Doctors: Healers as Patients At any one time, 15% of doctors will be impaired, unable to provide optimal care to patients due to physical or mental illness, including alcoholism, substance abuse, the effects of stress, and physi- cian incompetence.2 It is now, in the months of November, December, and January, that physi- cians in training historically face their greatest risk for depression. Tess Jones argues that impaired doctors are differ- ent than impaired stockbrokers: the personality characteristics that draw people into medicine of- ten pre-dispose them to substance abuse and de- pression. This is not to say that there is any one unifying personality “type” or explanation impli- cated in who is most at risk—although family his- tories of alcoholism, substance abuse, or depres- sion suggest genetics as contributing factors in 40- 60% of cases.3 It is to suggest that the rigorous resident training that encourages sleep deprivation and lengthy work shifts pushes many doctors into work habits that injure and impair them. These habits may result in destroyed marriages and other relationships, premature death or retirement. Ex- haustion and sleep deprivation may minimize ef- fective capabilities that are then combined with maximum responsibilities--expectations of flaw- less performance in situations where a misdiagno- sis might result in suffering or even death. Given this stressful medical training, it is not surprising

that Dr. Verghese,

in

doctors

with

addiction,

his experience studying found consistently that it

was not euphoria physicians sought, from the dysphoria of their existence. ing trends of suicide and depression, 4

but relief Disturb- as well as

substance abuse in the medical community challenged educators to reform. The July

have 2003

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